In the last few days I came across yet another interesting article [1] showing that prenatal stress is linked with shorter telomeres. Telomeres are those caps on the end of chromosomes that can fray and shorten with stress and age [3], are a classic biomarker for health. Shorter telomeres are bad news, heralding ill health, and indeed, early death, or in other words early stress might program the body to develop a faster metabolism, which also leads to faster ageing and more physical and mental illness. One recent meta-analysis looking at over 40 papers corroborated how early adversity, such as abuse or neglect, links with shorter telomere length [2].

Young people who had been in the care system are far more likely to die in early adulthood than their peers, a report showed last week; indeed they are at least 7 times more likely to die prematurely, before the age of 21. The BBC story about this highlighted poor access to mental health services, the lack of general support available, and the consequent over-use of drugs, alcohol and other forms of unhealthy self-medication and attempts to manage stressors.

I have worked with children in the care system for over 30 years and at least the research is showing what we have always known clinically. Bad early experiences lead young people to use drugs, alcohol, take risks in sexual and other behaviours, but also to struggle academically, socially and in their emotional wellbeing generally. Most of my most worrying cases in the NHS have been in the care system, and major crises often occur at the age when they are supposed to become ‘independent’ at the age when most well-adjusted children from loving families in fact rely on their families more than ever.

An NHS Trust in Yorkshire recently decided to deny non-urgent treatment to obese patients and also to smokers. A recent guardian article called this a form of discrimination similar to racism. It is true that we are facing an epidemic of obesity and linked health issues including diabetes and heart conditions. The solution is not to discriminate against or blame people who in many ways are already victims. There is a danger that our discourses about food and obesity become another way of blaming the poor for their poverty and its effects. People are criticised for being lazy, greedy, lacking control or selfish, yet often what drives eating is far outside consciousness and has sensible explanations.

Recently there has been a scurry of worrying statistics about a diabetes epidemic. Headlines suggest that diabetes is threatening to bankrupt the NHS, that there has been a 60% rise in cases in the past 10 years. Amazingly 3.3 million apparently are diagnosed with the disease, up 1.2 million in the last 10 years. Some predict further huge increases in the coming decades.

In the face of an encroaching obesity epidemic pundits constantly resort to simplistic and judgmental solutions, many of which blame sufferers, and worse, prescribe treatments and solutions that don’t work and don’t tackle the roots of the problem. Indeed our culture is rife with judgemental attitudes about weight and shape. Few of us are immune to preoccupations with our bodies, our kilo count, fat rolls, thigh sizes or belly width. Diet and food books consistently make the top 10 bestseller lists in the UK while rising obesity levels are seen as a huge threat to the NHS budget. While pubs serve ‘heart attack’ 2000 calorie burgers, rising numbers of ‘super-obese’ young people are being prescribed surgery. With all the angst, guilt and powerful opinionating we are too often left with a plethora of one-dimensional solutions and strident ideas, yet with too little understanding of what might lead to ‘issues’ of weight.

The labour party seem to be pledging to invest heavily in the NHS. While this is commendable there is a degree of naivety in how the crisis in healthcare is being understood. More than anything this is because the roots of so many health problems are in very early experiences, and start with psychological stressors, or rather psychobiological insults, which affect which genes are turned on or off, an epigenetic effect which indeed transmits across generations. An old fashioned medical model in which current, and purely physical, symptoms are identified and treated, can no longer be sufficient.